Postoperative Complications and Impact of Gender on Operative Treatment of Distal Radius Fractures

Background: Distal Radius Fracture Repair procedures remain commonly performed. While numerous studies have attempted to differentiate gender impact on operative outcomes, the literature remains inconclusive. In particular, gender impact on orthopedic procedures is controversial. In our study, we examined the effects of gender on postoperative complications following distal radius fracture repairs. We predict that males will have increased morbidity and mortality following operative treatment of distal radius fractures than their female counterparts. Methods: Data was collected from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) for all operative treatments for distal radius fractures from 2007 through 2014. Data includes preoperative demographic information and risk factors, perioperative events, and complications occurring within 30 days of initial surgical intervention. Subjects were identified using Current Procedural Terminology (CPT) codes. Primary CPT codes 25607, 25608, 25609 were used to identify patients receiving operative treatment for distal radius fractures. Two cohorts were defined in this study: (1) Male and (2) Female. Data on patients’ demographics, comorbidities, and postoperative complications were analyzed with univariate and multivariate analyses on SPSS software. Univariate analysis was performed using Pearson’s Chi-square for categorical variables or one-way ANOVA for continuous variables. Variables with p\u3c0.05 were selected for multivariate analyses. For the multivariate analyses, Poisson logistic linear regression analyses were performed to determine independent associations of risk factors for postoperative complications. Multivariate analysis results were reported as odds-ratios and 95% confidence intervals. A p-value of \u3c0.05 was used. Results: A total of 6,450 subjects were included in this study. Females comprised the majority of the study, with 4,675 (72%) patients. There were 1,775 male patients included in this study (28%). In total, there were 196 postoperative complications (4.2%) amongst females, and 75 postoperative complications (4.8%) seen in the male cohort. Men have an increased likelihood of failure to wean from anesthesia (p=0.022). There was no observed difference between males and females amongst all other comorbidities. Multivariate analysis did not identify gender as an independent risk for post-operative complications. Summary: There was no difference in postoperative complications based on gender analysis. Furthermore, Gender was not determined to be an independent risk factor for any post-operative complication. Overall complications for operative treatment of distal radius fractures were low for both groups. Based upon our results, risk for postoperative complications should not be stratified based off gender. Patients who stand to benefit from operative treatment of distal radius fractures should receive treatment

Low Serum Albumin Levels are Associated with Increased 30-Day Cardiopulmonary Complications, Reoperation, and Readmission Rates Following Total Shoulder Arthroplasty

Copyright © The Iowa Orthopaedic Journal 2019. Background: Hypoalbuminemia has been associated with several medical complications following surgery in a variety of orthopedic procedures. Hypoalbuminemia has previously been shown to have an increased risk for transfusions, hospital stay longer than three days, and mortality following total shoulder arthroplasty (TSA). This study seeks to further assess the relationship between low serum albumin and morbidity to allow surgeons to both preoperatively optimize patients and assess the risk of surgery prior to TSA. Methods: The American College of Surgeons National Surgical Quality Improvement Program® database was queried to identify 14,494 TSA patients, 6,129 (42.23%) who met inclusion criteria. Patients who had shoulder hemiarthroplasty, revision TSA, or incomplete serum albumin data were excluded. Demographic factors, preoperative comorbidities, and acute complication rates were assessed between hypoalbuminemic (n=485; 7.91%) and a propensity-matched control cohort (n=485), controlling for differences in patient demographics and comorbidities. Multivariate propensity-adjusted logistic regression analyses were used to assess hypoalbuminemia as an independent risk factor for specific postoperative complications. Results: Hypoalbuminemic patients undergoing TSA demonstrated significantly higher rates of pulmonary complications (p=0.006), unplanned intubation (p=0.014), DVT/PE (p=0.014), cardiac complications (p=0.033), infectious complications (p=0.025), blood transfusions (p\u3c0.001), reoperation (p=0.007), extended length of stay (\u3e 4 days) (p=0.036), unplanned readmission (p=0.001), and mortality (p=0.025) in the 30-day postoperative period when compared to the propensity-matched control cohort. On multivariate regression analyses, hypoalbuminemia independently increased the risk for pulmonary complications (OR 9.678, p=0.031), blood transfusions (OR 2.539, p\u3c0.001), reoperation (OR 5.461, p=0.032), and readmission (OR 2.607, p=0.007). Conclusions: Hypoalbuminemic patients undergoing TSA had increased rates of overall cardiac and pulmonary complications, unplanned intubations, DVT/PE\u27s, overall infectious complications, increased incidence of blood transfusions, reoperation, extended LOS (\u3e 4 days), readmission, and death. Multivariate analyses demonstrated that low albumin was independently associated with increased risk for pulmonary complications, blood transfusions, reoperation, and readmission. Preoperative albumin levels in patients undergoing TSA may help with preoperative risk stratification and optimization.Level of evidence: III